Eun Song Lee1, Jeong-Hoon Lim1, Jang-Hee Cho1, Hee-Yeon Jung1, Ji-Young Choi1, Sun-Hee Park1, Yong-Lim Kim1, Han Ro2, Sik Lee3, Seung-Yeup Han4, Cheol Woong Jung5, Jae Berm Park6, Myoung Soo Kim7, Jaeseok Yang8, Curie Ahn9, Chan-Duck Kim10. 1. Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea. 2. Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, South Korea. 3. Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea. 4. Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, South Korea. 5. Department of Surgery, Korea University College of Medicine, Seoul, South Korea. 6. Department of Surgery, Sungkyunkwan University, Seoul Samsung Medical Center, Seoul, South Korea. 7. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea. 8. Transplantation Center, Seoul National University Hospital, Seoul, South Korea. 9. Transplantation Center, Seoul National University Hospital, Seoul, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. 10. Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea. Electronic address: drcdkim@knu.ac.kr.
Abstract
BACKGROUND: There is a high risk of fracture after kidney transplantation (KT). Recipients of KT are susceptible to persistent hyperparathyroidism and other disorders of bone and mineral metabolism. However, the risk factors for fractures after KT remain uncertain. The aim of the present study was to investigate the risk factors for fracture after KT. METHODS: A total of 941 recipients of KT were enrolled from a multicenter observational cohort study in Korea from 2012 to 2016. The biochemical markers were measured at the time of KT, then annually for 5 years following KT. All fracture events were recorded. A Cox proportional hazards analysis was performed to calculate hazard ratios (HR) for the association of risk factors with fractures. RESULTS: Twenty-two fractures had occurred in 20 patients during the study period. Baseline and serial changes of mineral and bone biochemical markers were similar between fracture and nonfracture patient groups. Among the total study population, 104 patients were diagnosed with osteoporosis and 422 patients were diagnosed with osteopenia in a pretransplant bone mineral density test. In a multivariate Cox analysis, pretransplant osteoporosis (HR = 11.76; 95% confidence interval [CI], 2.28-60.69; P = .003) and pretransplant osteopenia (HR = 5.21; 95% CI, 1.15-23.57; P = .032) were independent risk factors for fracture in recipients of KT. CONCLUSIONS: Pretransplant osteoporosis and osteopenia were independent risk factors for fracture after KT. More careful monitoring of bone mineral density before and after KT might be beneficial to predict the risk for fracture after KT.
BACKGROUND: There is a high risk of fracture after kidney transplantation (KT). Recipients of KT are susceptible to persistent hyperparathyroidism and other disorders of bone and mineral metabolism. However, the risk factors for fractures after KT remain uncertain. The aim of the present study was to investigate the risk factors for fracture after KT. METHODS: A total of 941 recipients of KT were enrolled from a multicenter observational cohort study in Korea from 2012 to 2016. The biochemical markers were measured at the time of KT, then annually for 5 years following KT. All fracture events were recorded. A Cox proportional hazards analysis was performed to calculate hazard ratios (HR) for the association of risk factors with fractures. RESULTS: Twenty-two fractures had occurred in 20 patients during the study period. Baseline and serial changes of mineral and bone biochemical markers were similar between fracture and nonfracture patient groups. Among the total study population, 104 patients were diagnosed with osteoporosis and 422 patients were diagnosed with osteopenia in a pretransplant bone mineral density test. In a multivariate Cox analysis, pretransplant osteoporosis (HR = 11.76; 95% confidence interval [CI], 2.28-60.69; P = .003) and pretransplant osteopenia (HR = 5.21; 95% CI, 1.15-23.57; P = .032) were independent risk factors for fracture in recipients of KT. CONCLUSIONS: Pretransplant osteoporosis and osteopenia were independent risk factors for fracture after KT. More careful monitoring of bone mineral density before and after KT might be beneficial to predict the risk for fracture after KT.
Authors: Paolo Molinari; Carlo Maria Alfieri; Deborah Mattinzoli; Mariarosaria Campise; Angela Cervesato; Silvia Malvica; Evaldo Favi; Piergiorgio Messa; Giuseppe Castellano Journal: Front Med (Lausanne) Date: 2022-03-10